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Major or Mild Neurocognitive Disorder Due to Alzheimer's Disease
DSM-IV In DSM-IV, this disorder is called Dementia of the Alzheimer's Type For more information, see Dementia Diagnostic Criteria A'''. The development of multiple cognitive deficits manifested by both # memory impairment (impaired ability to learn new information or to recall previously learned information) # one (or more) of the following cognitive disturbances: #* '''a. aphasia (language disturbance) #* b'''. apraxia (impaired ability to carry out motor activities despite intact motor function) #* '''c. agnosia (failure to recognize or identify objects despite intact sensory function) #* d'''. disturbance in executive functioning (i.e., planning, organizing, sequencing, abstracting) '''B. The cognitive deficits in Criteria A1 and A2 each cause significant impairment in social or occupational functioning and represent a significant decline from a previous level of functioning. C'''. The course is characterized by gradual onset and continuing cognitive decline. '''D. The cognitive deficits in Criteria A1 and A2 are not due to any of the following: # other central nervous system conditions that cause progressive deficits in memory and cognition (e.g., cerebrovascular disease, Parkinson's disease, Huntington's disease, subdural hematoma, normal-pressure hydrocephalus, brain tumor) # systemic conditions that are known to cause dementia (e.g., hypothyroidism, vitamin B12 or folic acid deficiency, niacin deficiency, hypercalcemia, neurosyphilis, HIV infection) # substance-induced conditions E'''. The deficits do not occur exclusively during the course of a delirium. '''F. The disturbance is not better accounted for by another disorder (e.g., Major Depressive Disorder, Schizophrenia). Specify type of onset and predominant features: * With Early Onset: if onset is at age 65 years or below ** With Delirium: if delirium is superimposed on the dementia ** With Delusions: if delusions are the predominant feature ** With Depressed Mood: if depressed mood (including presentations that meet full symptom criteria for a Major Depressive Episode) is the predominant feature. A separate diagnosis of Mood Disorder Due to a General Medical Condition is not given. ** Uncomplicated: if none of the above predominates in the current clinical presentation * With Late Onset: if onset is after age 65 years ** With Delirium: if delirium is superimposed on the dementia ** With Delusions: if delusions are the predominant feature ** With Depressed Mood: if depressed mood (including presentations that meet full symptom criteria for a Major Depressive Episode) is the predominant feature. A separate diagnosis of Mood Disorder Due to a General Medical Condition is not given. ** Uncomplicated: if none of the above predominates in the current clinical presentation Specify if: * With Behavioral Disturbance Note: Also record Alzheimer's disease Subtypes and Specifiers Age at onset The age at onset of Dementia of the Alzheimer's Type can be indicated by the use of one of the following subtypes: With Early Onset This subtype is used if the onset of dementia is age 65 years or under. With Late Onset This subtype is used if the onset of the dementia is after age 65 years. Predominant feature The following subtypes must be used to indicate the predominant feature of the current clinical presentation: With Delirium This subtype is used if delirium is superimposed on the dementia. With Delusions This subtype is used if delusions are the predominant feature. With Depressed Mood This subtype is used if depressed mood (including presentations that meet symptom criteria for a Major Depressive Episode) is the predominant feature. A separate diagnosis of Mood Disorder Due to a General Medical Condition is not given. Uncomplicated This subtype is used if none of the above predominates in the current clinical presentation. With Behavioral Disturbance The specifier With Behavioral Disturbance can also be used to indicate clinically significant behavioral disturbances (e.g., wandering). Recording Procedures The specifier With Behavioral Disturbance can be applied to any of the subtypes (e.g., Dementia of the Alzheimer's Type, With Late Onset, With Depressed Mood, With Behavioral Disturbance). In addition, Alzheimer's disease should be recorded. DSM-5 For more information, see Major and Mild Neurocognitive Disorders Diagnostic Criteria A'''. The criteria are met for major or mild neurocognitive disorder. '''B. There is insidious onset and gradual progression of impairment in one or more cognitive domains (for major neurocognitive disorder, at least two domains must be impaired). C'''. Criteria are met for either probable or possible Alzheimer's disease as follows: ''For major neurocognitive disorder'' '''Probable Alzheimer's disease is diagnosed if either of the following is present; otherwise, possible Alzheimer's disease should be diagnosed. # Evidence of a causative Alzheimer's disease genetic mutation from family history or genetic testing. # All three of the following are present: #* a'''. Clear evidence of decline in memory and learning and at least one other cognitive domain (based on detailed history or serial neuropsychological testing). #* '''b. Steadily progressive, gradual decline in cognition, without extended plateaus. #* c'''. No evidence of mixed etiology (i.e., absence of other neurodegenerative or cerebrovascular disease, or another neurological, mental, or systemic disease or condition likely contributing to cognitive decline). ''For mild neurocognitive disorder'' '''Probably Alzheimer's disease is diagnosed if there is evidence of a causative Alzheimer's disease genetic mutation from either genetic testing or family history. Possible Alzheimer's disease is diagnosed if there is no evidence of a causative Alzheimer's disease genetic mutation from either genetic testing or family history, and all three of the following are present: # Clear evidence of decline in memory and learning. # Steadily progressive, gradual decline in cognition, without extended plateaus. # No evidence of mixed etiology (i.e., absence of other neurodegenerative or cerebrovascular disease, or another neurological or systemic disease or condition likely contributing to cognitive decline). D'''. The disturbance is not better explained by cerebrovascular disease, another neurodegenerative disease, the effects of a substance, or another mental, neurological, or systemic disorder. '''Differential Diagnosis Other neurocognitive disorders Major and mild NCDs due to other neurodegenerative processes (e.g., Lewy body disease, frontotemporal lobar degeneration) share the insidious onset and gradual decline caused by Alzheimer's disease but have distinctive core features of their own. In major or mild vascular NCD, there is typically history of stroke temporally related to the onset of cognitive impairment, and infarcts or white matter hyperintensities are judged sufficient to account for the clinical picture. However, particularly when there is no clear history of stepwise decline, major or mild vascular NCD can share many clinical features with Alzheimer's disease. Other concurrent, active neurological or systemic illness Other neurological or systemic illness should be considered if there is an appropriate temporal relationship and severity to account for the clinical picture. At the mild NCD level, it may be difficult to distinguish an Alzheimer's disease etiology from that of another medical condition (e.g., thyroid disorders, vitamin B12 deficiency). Major depressive disorder Particularly at the mild NCD level, the differential diagnosis also includes major depression. The presence of depression may be associated with reduced daily functioning and poor concentration that may resemble an NCD, but improvement with treatment of depression may be useful in making the distinction.